- Hospital Outpatient Prospective Payment System reimbursement rate doubled, expanding access to CCTA and supporting the technology's superior accuracy and efficiency in cardiac care
- New payment rates also confirmed supporting access to HeartFlow FFRCT and Plaque Analysis for patients with coronary artery disease
MOUNTAIN VIEW, Calif., Nov. 01, 2024 (GLOBE NEWSWIRE) -- HeartFlow, Inc. the global leader in non-invasive artificial intelligence (AI) heart care solutions, today announced the Centers for Medicare & Medicaid Services (CMS) released a final rule elevating the ambulatory payment classification (APC) of Coronary Computed Tomography Angiography (CCTA), increasing reimbursement from $175 to $357 for CCTA Hospital Outpatient Prospective Payment System (OPPS) services and increasing Physician Fee Schedule (PFS) global payment to $318, effective January 2025 for Medicare patients. The decision was supported by a growing body of clinical evidence demonstrating the diagnostic test's accuracy and efficiency and advocated for by a coalition of healthcare providers led by the Society of Cardiovascular Computed Tomography (SCCT).
These reimbursement increases align with CMS's ongoing commitment to advance cardiac care and improve patient outcomes, making it more advantageous for institutions to adopt CCTA in the diagnosis and treatment of patients with coronary artery disease (CAD). Commercial payer payment rates for CCTA can range from $175 to $2,500.1 HeartFlow encourages providers to collaborate with commercial payers to ensure their contracts reflect the updated CMS rates and the recognized value of CCTA in cardiac care.
"Physicians have increased the use of CCTA an average of 20% annually over the last five years. This reimbursement reflects CMS's recognition of the benefits CCTA offers, including superior imaging versus other non-invasive imaging modalities, efficient patient pathway guidance, and reductions in unnecessary tests,” said Maros Ferencik, M.D., Ph.D., President of SCCT and Professor of Medicine and Radiology and Section Head of Cardiovascular Imaging at Oregon Health & Sciences University. "This is an exciting step forward for healthcare providers. SCCT proudly supports this important increase in reimbursement to facilitate more accurate diagnosis and care for patients with cardiovascular disease.”
From one single test, CCTA provides a comprehensive view of a patient's CAD and guides treatment planning when combined with HeartFlow fractional flow reserve computed tomography (FFRCT) and Plaque Analysis. In addition to the CCTA rate increases, the CMS payment rate for the HeartFlow FFRCT Analysis is increasing from $997 to $1,017 for 2025 and the payment rate for Artificial Intelligence-Enabled Quantitative Plaque Analysis (AI-QPA) services including the HeartFlow Plaque Analysis will be set at $950. These reimbursement decisions better align financial incentives with clinical outcomes, empowering providers to leverage advanced imaging technologies for superior patient care.
HeartFlow Plaque Analysis also recently received a favorable coverage decision by Medicare Administrative Contractors and a Category I Current Procedural Terminology (CPT®) code, supporting access across the U.S. and recognizing the value and critical role of AI-enabled plaque quantification technologies in cardiovascular disease management.
"These substantial reimbursement increases from CMS and coverage policies support what HeartFlow and many physicians and institutions have known - CCTA is the future of CAD diagnostics and is a critically important guideline-recommended test for patients with suspected coronary artery disease,” said Campbell Rogers, M.D., F.A.C.C., Chief Medical Officer of HeartFlow. "We thank SCCT and the American Colleges of Cardiology and Radiology along with the cardiac imaging community for supporting these important increases in reimbursement rates, which will further incentivize clinicians to use this pathway. A CCTA pathway combined with HeartFlow FFRCT and HeartFlow Plaque Analysis gives physicians the most comprehensive information for diagnosing and managing CAD.”
HeartFlow is dedicated to reshaping cardiovascular care and ensuring that physicians and patients have access to comprehensive, accurate, and efficient solutions in precision coronary care. HeartFlow has been adopted by more than 1,300 institutions globally and continues to strengthen its commercial presence and reimbursement to make this cutting-edge solution more widely available to an increasingly diverse patient population worldwide.
About HeartFlow, Inc.
HeartFlow is transforming precision coronary care with the only AI-powered non-invasive integrated heart care solution across the CCTA pathway. As the pioneer of FFRCT, which is now supported by the ACC/AHA Chest Pain Guideline, HeartFlow continues to advance the diagnosis and management of CAD. HeartFlow's suite of non-invasive technologies includes its FFRCT Analysis, RoadMap™ Analysis, and Plaque Analysis. More than 500 peer-reviewed publications have validated our approach and more importantly, our technologies have helped clinicians diagnose and manage over 250,000 patients. For more information, visit www.heartflow.com.
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References
1. Data on file.
2. Gulati, et al. 2021 AHA/ACC/ASE/CHES/SAEM/SCCT/SCMR Guideline for the Evaluation & Diagnosis of Chest Pain. Circulation.
